Hospital E/M question

renee.knutsen@hopeorthopedics.com

When our providers see a patient in the hospital sometimes the patient is listed as outpatient with observation service. We trying to figure out if we use the outpatient codes (99201-99215) or do we use the observation code (99218-99220) for the e/m. Any ideas?

laurie.johnson@hrhonline.org

What we do is the provider we are coding for is the admitting physician we use 99218-99220 but if he is the PCP or consulting & not admitting we use the outpatient new/established or consult codes depending on circumstances.


Laurie Johnson
Laurie Johnson, CCS, COC
Certified Coder
Hannibal Regional Healthcare System
573-248-5421 (O)
Laurie.johnson@hrhonline.org

Erica

You want to use the subsequent observation codes if you are not the provider who admitted patient to observation. Only the admitting physician can bill initial obs codes (which differs from initial inpatient codes). If it's the rare the payor who still pays for consults and it was actually a consult, then the outpatient consult codes would be appropriate.

CPT GUIDELINES:
“New or Established Patient Initial Hospital Observation Care Services

The following codes are used to report the encounter(s) by the supervising physician or other qualified health care professional with the patient when designated as "observation status." This refers to the initiation of observation status, supervision of the care plan for observation and performance of periodic reassessments. For observation encounters by other physicians, see office or other outpatient consultation codes (99241-99245) or subsequent observation care codes (99224-99226) as appropriate."

jacquelyn.valdivia@sharp.com

For Medicare, a consulting provider should bill new or established outpatient code with location 22.

See CMS CPM Chapter 12. 30.6.8 section A:

For example, if an internist orders observation services and asks another physician to additionally evaluate the patient, only the internist may bill the initial and subsequent observation care codes. The other physician who evaluates the patient must bill the new or established office or other outpatient visit codes as appropriate.

jcossin

We run into a problem using the subsequent codes for Humana, they are denying saying only one provider a day is allowed to bill the admission or the subsequent codes. We are general surgery so when we get consulted it becomes an issue.

Jennifer Cossin
Billing Manager
Central Ohio Surgical Associates, Inc.
(614) 866-4270
(614) 866-4271 (fax)
jcossin@cosadocs.com





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dbroyles@utmck.edu

APPEAL - APPEAL - APPEAL
We are getting these too. We are appealing, with a letter stating different taxonomy codes, different practices, and different specialties.



Thanks

Deborah Broyles, CPC
Supervisor/Coding Specialist
University Radiation Oncology/University Surgical Oncology
865-305-9886 phone / 865-305-9714 Fax

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lraab@stmarys.org

That is correct. Only the provider (or group) that admitted the patient to obs can charge the subs obs charges. Anyone else has to bill the new or established outpatient codes 99201-99215

mlewis@scrogginsgrear.com

Add different diagnoses.



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seth.canterbury@jax.ufl.edu

Both Erica and Leann were correct, depending on the payer.

Here's the dealio:

When the Subsequent Observation Care codes were released, CPT said that they could be used in much the same way as Subsequent (Inpatient) Hospital Care codes were, in that they were to be used primarily by the admitting specialty for care occurring between the day of admission and the day of discharge—true—but were also available for use by other specialties seeing the admitted patient during any day of their stay when a consult code did not apply. For CPT, only the Initial Care and Discharge code categories were restricted for use only by the admitting/attending specialty.

Medicare, in their never-ending desire to be different, took a more restrictive stance for the new Subsequent Observation Care codes, and said that only the admitting/attending specialties could use the subsequent visit codes from this particular category and that other specialties seeing the patient should bill for observation care using the Outpatient Office Visit codes.

Some Medicare managed care plans followed Medicare's lead, while almost every commercial insurer that I know of follows CPT's direction. So everybody is right, depending on the payer.

Seth